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Ethical Dilemma: Pediatric Complexologist and a Pediatric Palliative Care and Ethics Consultant Essay.

Ethical Dilemma: Pediatric Complexologist and a Pediatric Palliative Care and Ethics Consultant Essay.Ethical Dilemma: Pediatric Complexologist and a Pediatric Palliative Care and Ethics Consultant Essay.Your topic: Ethical Dilemma on Pediatric Complexologist and a Pediatric Palliative Care and Ethics Consultant.Commentary From a Pediatric Complexologist and a Pediatric Palliative Care and Ethics Consultant.Directions; Powerpoint and summary of both 1 and 21. Plans to resolve the dilemma2. Key points NR328 Pediatric Nursing RUA: Ethical Dilemma Assignment GuidelinesNR328 Ethical Dilemma Guidelines V6.docx Revised:PurposeFor this assignment, you will examine an ethical dilemma that exists in pediatric settings with a group of your peers. You will examine the ethical dilemma from two opposing positions and consider ethical principles, conflict between the principles and the relationship of the ANA Code of Ethics in relation to both positions. You will also discuss potential resources, possible outcomes of both positions and develop a plan for resolving the issue (for patient, family and the nurse). Your team will then present this information in class with a poster grounded in scholarly sources. You will also submit individual speaker notes describing your assigned part and reflection on your values.Ethical Dilemma: Pediatric Complexologist and a Pediatric Palliative Care and Ethics Consultant Essay.ORDER A PLAGIARISM-FREE PAPER HERECourse outcomes: This assignment enables the student to meet the following course outcomes: 1. Provides individualized comprehensive care for children and their families with multiple health problems ininstitutions and community care settings from birth through adolescence. (PO 1) 4. Utilizes critical thinking skills in clinical decision making in the care of pediatric clients. (PO 4) 6. Utilizes legal, ethical, and professional standards and principles, including those related to child abuse recognitionand intervention, as a basis for pediatric clinical decision‐making. (PO 6) 8. Utilize research findings as a basis for nursing interventions in pediatric healthcare settings and the development ofprofessional nursing papers. (PO 8)Due date: Your faculty member will inform you when this assignment is due. The Late Assignment Policy applies to this assignment.Total points possible: 100 pointsPreparing the assignment Follow these guidelines when completing this assignment. Speak with your faculty member if you have questions. 1) An ethical dilemma with opposing positions will be assigned by your instructor. 2) A template for the poster will be made available. 3) Although you may not agree with one of the positions, reflect on your views, respect other perspectives, andexamine scholarly literature on both positions. 4) Form a group of 5‐6 students. 5) Each student is responsible for an assigned part:Ethical Dilemma: Pediatric Complexologist and a Pediatric Palliative Care and Ethics Consultant Essay.a. Team Leader • Prepares and submits the poster on behalf of the group. The poster must clearly indicate the specific partthat each team member completed. Describes statistical significance to pediatric nursing grounded in scholarly literature. Collates utilized references and summarizes key points.b. Description of the dilemma • Performs preliminary research on the assigned ethical dilemma and describes the dilemma. Clearlyidentifies both positions grounded in scholarly literature. Disseminates information found to all group members.c. Ethical Principles and ANA Code of Ethics Provisions (2) • Determines the ethical principles that apply to each position, possible conflicts in principles, andcomponents of the ANA Code of Ethics that apply using three (3) Provisions. Disseminates information found to all group members. Supports ideas with scholarly literature.d. Resources to resolve the dilemma • Describes resources to resolve the dilemma and describes how each resource could help to resolve thedilemma. Supports ideas with scholarly literature. e. Possible outcomes and plan for resolving the issue• Discusses possible outcomes of both positions. Presents a plan for resolving the issue (for patient, family and the nurse). Supports ideas with scholarly literature.Ethical Dilemma: Pediatric Complexologist and a Pediatric Palliative Care and Ethics Consultant Essay.6) Each team member will provide their part of the poster to the team leader including citations and references.  NR328 Pediatric Nursing RUA: Ethical Dilemma Assignment GuidelinesNR328 Ethical Dilemma Guidelines V6.docx Revised: 3/2020 2 Ethical Dilemma: Pediatric Complexologist and a Pediatric Palliative Care and Ethics Consultant Essay.7) Each team member will complete and submit speaker notes of their assigned part and a reflection of own values and morals as it relates to the ethical dilemma. The title page must clearly indicate the specific part that the team member completed. Can be bullet points, listed, or written out.8) Practice as a group how you will present this issue. Make notes for your reference during the presentation and be prepared to discuss your scholarly literature.9) Each team member will present their assigned part of the poster to the class. The presentation will last no more than 15 minutes.10) Use this link to take you directly to the ANA website to access the Code of Ethics. When prompted, choose “No I do not wish to register at this time. Take me to the Code now.” https://www.nursingworld.org/practice‐ policy/nursing‐excellence/ethics/code‐of‐ethics‐for‐nurses/11) For APA, formatting, or grammar assistance visit the APA Citation and Writing page in the online library. 12) Include the following sections (detailed criteria listed below and in the Grading Rubric):Ethical Dilemma: Pediatric Complexologist and a Pediatric Palliative Care and Ethics Consultant Essay.a. Professionalism ‐5 points/5% • Team members are professionally dressed. • Team is introduced and assigned roles are identified prior to starting the presentation. • Full group participation. • Respectful and professional language is used throughout the presentation. • Adhere to the time limit of 15 minutes.b. Team Presentation ‐50 points/50% • Description of the dilemma is clear and includes statistical significance to Pediatric nursing. • Both positions of the dilemma are presented crediting supporting scholarly sources. • Appropriate ethical principle(s) to support each position are used. • Consideration of which, if any, ethical principles are in conflict with the opposing positions. • Three (3) provisions of the ANA Code of Ethics that apply to the ethical dilemma are used. • Present all pertinent resources available to resolve the dilemma. • Explain how resources could help in resolving the dilemma. • Discuss possible outcomes of each position. • Present a plan for resolving the issue.c. Team Poster ‐ 15 points/15% • Full names of all team members included and team member initials are present in the assigned sections. • Content is presented clearly and scholarly. • Citations included for each section. • Poster includes sections for:Ethical Dilemma: Pediatric Complexologist and a Pediatric Palliative Care and Ethics Consultant Essay.o Title o Dilemma description o Statistical significance o Ethical principles o Applicable ANA Code of Ethics Provisions o Resources to resolve dilemma o Potential outcomes of the dilemma o Plan for resolving the dilemma o Key Points o Referencesd. Speaker Notes and Reflection‐ 20 points/20% • APA Title page with assigned individual part identified. • Ideas presented clearly. • APA citations throughout. https://www.nursingworld.org/practice-policy/nursing-excellence/ethics/code-of-ethics-for-nurses/https://www.nursingworld.org/practice-policy/nursing-excellence/ethics/code-of-ethics-for-nurses/https://library.chamberlain.edu/APA NR328 Pediatric Nursing RUA: Ethical Dilemma Assignment GuidelinesNR328 Ethical Dilemma Guidelines V6.docx Revised: 3/2020 3Ethical Dilemma: Pediatric Complexologist and a Pediatric Palliative Care and Ethics Consultant Essay. • At least two (2) nursing, peer reviewed, primary sources from the last 5 years, excluding the textbook used to support work.• APA reference page. • Reflection of own values and morals.e. Poster APA Style and Organization – 10 points/10% • References are submitted with assignment. • Uses current APA format and is free of errors. • Grammar and mechanics are free of errors. • At least three (3) scholarly, nursing, peer reviewed, primary sources from the last 5 years, excluding thetextbook, are provided • One (1) scholarly source must be the ANA Code of Ethics Provisions and each position must be supportedby a scholarly source.  NR328 Pediatric Nursing RUA: Ethical Dilemma Assignment Guidelines NR328 Ethical Dilemma Guidelines V6.docxRevised: 3/2020 4 Ethical Dilemma: Pediatric Complexologist and a Pediatric Palliative Care and Ethics Consultant Essay. Grading Rubric Criteria are met when the student’s application of knowledge demonstrates achievement of the outcomes for this assignment.Assignment Section and Required Criteria(Points possible/% of total points available)Highest Level ofPerformanceHigh Level of PerformanceSatisfactory Level ofPerformancUnsatisfacto ry Level ofPerformancSection notpresentProfessionalism (5 points/5%)5 points 4 points 3 points 2 points 0 pointsRequired criteria 1. Team members are professionally dressed. 2. Team is introduced and assigned roles are identified priorto starting the presentation. 3. Full group participation. 4. Respectful and professional language is used throughoutthe presentation. 5. Adhere to the time limit of 15 minutes.Includes no fewer than 5 requirements for section.Includes no fewer than 4 requirements for section.Includes no less than 3 requirement for section.Includes no less than 2 requirement for section.Ethical Dilemma: Pediatric Complexologist and a Pediatric Palliative Care and Ethics Consultant Essay.Includes 1 or no requirements for section.Team Presentation (50 points/50%)50 points 40 points 30 points 20 points 0 pointsRequired criteria 1. Description of the dilemma is clear and includes statisticalsignificance to Pediatric nursing. 2. Both positions of the dilemma are presented creditingsupporting scholarly sources. 3. Appropriate ethical principle(s) to support each positionare used. 4. Consideration of which, if any, ethical principles are inconflict with the opposing positions. 5. Three (3) provisions of the ANA Code of Ethics that apply tothe ethical dilemma are used. 6. Present all pertinent resources available to resolve thedilemma. 7. Explain how resources could help in resolving the dilemma. 8. Discuss possible outcomes of each position. 9. Present a plan for resolving the issue. Includes no fewer than 9 requirements for section.Includes no fewer than 8 requirements for section.Includes no fewer than 7 requirements for section.Includes no fewer than 6 requirements for section.Includes 5 or fewer requirements for section.  NR328 Pediatric Nursing RUA: Ethical Dilemma Assignment Guidelines NR328 Ethical Dilemma Guidelines V6.docx Ethical Dilemma: Pediatric Complexologist and a Pediatric Palliative Care and Ethics Consultant Essay. Team Poster (15 points/15%)15 points 10 points 7 points 5 points 0 pointsRequired criteria 1. Full names of all team members included and teammember initials are present in the assigned sections. 2. Content is presented clearly and scholarly. 3. Citations included for each section. 4. Poster includes sections for title, dilemma description,Statistical significance, Ethical principles, Applicable ANA Code of Ethics Provisions, Resources to resolve dilemma, Potential outcomes of the dilemma, Plan for resolving the dilemma, Key Points, and References.Includes no fewer than 4 requirements for section.Includes no fewer than 3 requirements for section.Includes no fewer than 2 requirements for section.Includes no less than 1 requirements for section.No requirements for this section presented.Speaker Notes and Reflection (20 points/20%)20 points 15 points 10 points 5 points 0 pointsRequired criteria 1. Title page with assigned individual part identified. 2. Citations throughout. 3. Ideas presented clearly. 4. At least two (2) sources used to support work. 5. Reference page. 6. Reflection of own values and morals.Includes no fewer than 6 requirements for section.Includes no fewer than 5 requirements for section.Includes no fewer than 4 requirements for section.Ethical Dilemma: Pediatric Complexologist and a Pediatric Palliative Care and Ethics Consultant Essay.Includes no fewer than 3 requirements for section.Includes 2 or fewer requirements for section.Poster APA Style and Organization (10 points/10%)10 points 8 points 6 points 4 points 0 points1. References are submitted with assignment. 2. Uses current APA format and is free of errors. 3. Grammar and mechanics are free of errors. 4. At least three (3) scholarly, peer reviewed, primarysources from the last 5 years, excluding the textbook, are provided5. One (1) scholarly source must be the ANA Code of Ethics and each position must be supported by a scholarly source.Includes no fewer than 5 requirements for section.Includes no fewer than 4 requirements for section.Includes no fewer than 3 requirements for section.Includes 1‐2 requirements for section.No requirements for this section presented.Total Points Possible = 100Ethical Dilemma: Pediatric Complexologist and a Pediatric Palliative Care and Ethics Consultant Essay. PurposePreparing the assignmentCase CommentariesCommentary From a Pediatric Complexologist and a PediatricPalliative Care and Ethics Consultant Carl Tapia, Baylor College of MedicineJill Ann Jarrell, Baylor College of MedicineThe case of Marcy and JR illustrates some common yet exquisitely challenging ethical dilemmas in pediatric palli- ative care, namely, those of feeding, proxy caregiving, and the principle of double effect. Here we attempt to dissect each of these issues and offer our opinion on potential interventions and management strategies.Ethical Dilemma: Pediatric Complexologist and a Pediatric Palliative Care and Ethics Consultant Essay.Artificial hydration and nutrition are common in chil- dren with medical complexity (and specifically those with mitochondrial disorders), but are not without complica- tions. One review reported that up to 20% of patients with long-term tube feeding had significant leakage concerns (Chang et al. 2014). Gastrojejunal (G-J) tube placement is an increasingly common procedure in neurologically impaired children with feeding intolerance, but complications with this procedure include breakage, dislodgement, obstruction, and even death from intestinal perforation (Al-Zubeidi et al. 2013; King et al. 2013). Symptom burden from these complications can include pain, both from the potential complication and the repeated replacement of feeding tubes; fatigue, from the change in fluid and calorie balance as well as repeated visits to the health care provider; consti- pation; nausea; vomiting; rash; and caregiver fatigue.Thus, reversible causes (such as medication side effects, obstruction, or technical malfunctions) of feeding intolerance should be evaluated and treated (Schwantes and O’Brien 2014). Then, symptom burden should be ascertained as already outlined. Also, the goals of having the feeding tube should be reassessed.Ethical Dilemma: Pediatric Complexologist and a Pediatric Palliative Care and Ethics Consultant Essay.In the adult palliative care world it has long been taught that feeding tubes may be life-prolonging in select circumstances: patients with good functional status and a proximal gastrointestinal (GI) obstruction due to cancer or who are receiving chemotherapy for a proximal GI cancer, selected HIV patients, and patients with amyotrophic lat- eral sclerosis. There is no data to support that feeding tubes prolong or improve life for patients with static or degenerative encephalopathies such as dementia or stroke,presumably analogous conditions to those of our patient, Marcy. In fact, some data suggest that feeding tubes do more harm than good in these populations with high rates of aspiration pneumonia, obstruction, pain, bleeding, and other complications (Hallenback 2009). We would need to clarify the original intention of placing the feeding tube, whether the intended goal was ever attained, whether the intended goal currently is being met, and whether the orig- inal goal of placing the feeding tube is still achievable at all. Assuming the feeding tube was placed to achieve life prolongation via caloric support in Marcy, has this goal been achieved? Is it still possible?Ethical Dilemma: Pediatric Complexologist and a Pediatric Palliative Care and Ethics Consultant Essay.In this case, the caregiver objects to the placement of a G-J tube, citing fears about increasing suffering. The caregiver role as expert in her child, with insight into acceptable risks and impact on quality of life, is a central philosophy in pediatric palliative care, as is the concept that once-restorative therapies can become bur- densome as the trajectory of illness changes (Schwantes and O’Brien 2014). By this evaluation, the caregiver refusal for G-J tube placement and even withdrawal of feeding altogether are compelling if the risks of place- ment and side effects of tube feeding are significant and debilitating, and the exacerbation of feeding intol- erance is considered to be an “end-of-life symptom” (Schwantes and O’Brien 2014). From the caregiver per- spective, escalation of feeding interventions may be considered to add little benefit to the child and to cause harm (Schwantes and O’Brien 2014). Furthermore, stud- ies have validated the reliability of the parent caregiver in reporting pain in children of varying ages and even those with cognitive impairment (Chambers et al. 2003; Voepel-Lewis et al. 2002), although these studies related particularly to postoperative pain.Ethical Dilemma: Pediatric Complexologist and a Pediatric Palliative Care and Ethics Consultant Essay.In pediatrics, we often believe the entire family to be our patient as we deal with the physiology of the child and the emotions, desires, and intellect of both the child andAddress correspondence to Carl Tapia, MD, MPH, FAAP, Assistant Professor of Pediatrics, Department of Pediatrics, Baylor College of Medicine, 6701 Fannin St #1730, Houston, TX 77030, USA. E-mail: ct692423@bcm.edu70 ajobThe American Journal of Bioethics, 16(2): 70–75, 2016DOI: 10.1080/15265161.2015.1132041parents. In this particular case, JR is Marcy’s voice and decision maker; she is in a sense our patient as well, and attention should be directed to her needs. Is JR well physi- cally and emotionally, or is she perhaps suffering from anticipatory grief as she watches her child decline? If this is indeed the case, is JR receiving any social and/or psy- chological assistance? Is her decision-making ability intact? Is she receiving enough help at home?Shifting our focus back to Marcy, we need to know more about her ability to communicate, both verbally and nonverbally, to determine the extent to which she can express her symptoms as well as her desires and the degree to which we need to rely on JR as the proxy symp- tom reporter. One of the guiding principles of ethics is patient autonomy, which, in pediatrics, is often manifest as the concept of “assent,” which is including the pediatric patient in the decision-making process, even though the patient cannot legally “consent.” We are unclear whether or not assent can be obtained from Marcy for treatment or withdrawal thereof.Ethical Dilemma: Pediatric Complexologist and a Pediatric Palliative Care and Ethics Consultant Essay.The therapeutic relationship between the family and caregiver team is undoubtedly strained when there is dis- agreement about the utility versus futility of feeding inter- ventions. Perhaps the principle of double effect could be explored with the family and health care team—is the undesired effect (failure to thrive and possible death) acceptable given that the desired effect (relief of suffering from feeding intolerance) is intended by not offering the intervention (G-J tube or withdrawal of feeds)? It is also important to discuss that worsening nutrition and possible death are not intended to directly achieve relief of suffer- ing from feeding intolerance (the undesired effects are not the direct means of achieving the desired effect, even though they may be likely to occur). However, concluding that the desired relief from suffering outweighs the nega- tives of worsening nutrition and even death requires con- sidering other less harmful options for achieving the desired effect. This may include a trial of nasojejunal feeds, hydration with clear fluids, or slowing of feeds (Morrison and King 2014).Ethical Dilemma: Pediatric Complexologist and a Pediatric Palliative Care and Ethics Consultant Essay.As a point of interest, some posit that the principle of double effect is irrelevant in end-of-life care because it requires there to be a bad effect that needs justification. This is not the case in end-of-life care for patients diag- nosed as dying. Here, bringing about a satisfactory dying process for a patient is a good effect, not a bad one. What matters is that patients die without pain and suffering. This marks a crucial departure from the double-effect doc- trine; if the patient’s death is not a bad effect then the doc- trine is clearly irrelevant. A diagnosis of dying allows clinicians to focus on good dying and not to worry about whether their intervention affects the time of death (Allmark et al. 2010).Ethical Dilemma: Pediatric Complexologist and a Pediatric Palliative Care and Ethics Consultant Essay.Is Marcy dying? Given her stated failure to thrive, it appears so. However, would she continue to fail to thrive if a G-J tube was placed? That is the million-dollar ques- tion. Implicit in defining the meaning of death is discern- ing the meaning of life. Given the complexity of Marcyand JR’s scenario and the now numbered specialists involved in her care, this is perhaps best addressed by a formal ethics consultation, which would begin as we have begun here, by assessing Marcy. We would look at her, touch her, and attempt to communicate with her in an effort to understand her symptom burden as well as her desires. We would spend time getting to know JR as well and attempt to learn about their life together, perhaps with other family members and at home. We would then inquire about goals of care and try to align these goals of care to present and possible care plans.Ethical Dilemma: Pediatric Complexologist and a Pediatric Palliative Care and Ethics Consultant Essay.Typically, an ethics consult is not a solitary event, but rather a series of meetings and conversations, with the fam- ily, with health care providers, among the ethics committee, and often all of these. If successful mediation, mutual understanding, and shared decision making toward a cohe- sive care plan are not attained through this sometimes lengthy process, social or legal assistance outside of the institution may be sought; however, this is reserved for the most challenging of cases and is done rarely. &REFERENCESAllmark, P. L., M. Cobb, B. J. Liddle, and A. M. Tod. 2010. Is thedoctrine of double effect irrelevant in end-of-life decision making?Nursing Philosophy 11(3): 170–7.Ethical Dilemma: Pediatric Complexologist and a Pediatric Palliative Care and Ethics Consultant Essay.Al-Zubeidi, D., et al. 2013. Gastrojejunal feeding tube use by gas-troenterologists in a pediatric academic center. Journal of PediatricGastroenterology and Nutrition 56(5): 523–27.Bizzarri, C., et al. 2011. Dumping syndrome: An unusual cause ofsevere hyperinsulinemic hypoglycemia in neurologically impairedchildren with gastrostomy. Minerva Pediatrica 63(1): 67–71.Chambers, C. T., G. A. Finely, P. J. McGrath, and T. M. Walsh.2003. The parents’ postoperative pain measure: Replication andextension to 2–6 year old children. Pain 105(3): 437–43.Chang, W. K., et al. 2014. Prospective evaluation of peristomal cuta-neous changes among patients with long-term percutaneous endo-scopic gastrostomy. Advances in Skin & Wound Care 27(6): 260–7.Hallenback, J. 2009. Tube feed or not tube feed? Center to AdvancePalliative Care, Hospice Fast Fact #10. Available at: https://www.capc.org/fast-facts/10-tube-feed-or-not-tube-feedKing, M., et al. 2014. Effect of gastrojejunal feedings on visits andcosts in children with neurologic impairment. Journal of PediatricGastroenterology and Nutrition 58(4): 518–24.Morrison, W. and T. Kang. 2014. Judging the quality of mercy:Drawing a line between palliation and euthanasia. Pediatrics 133(Suppl 1): S31–36.Schwantes, S. and H. W. O’Brien. 2014. Pediatric palliative care forchildren with complex chronic medical conditions. Pediatric Clinicsof North America 61(4): 797–821.Ethical Dilemma: Pediatric Complexologist and a Pediatric Palliative Care and Ethics Consultant Essay.Voepel-Lewis, T., S. Merkel, A. R. Tait, A. Trzcinka, and S. Mal-viya. 2002. The reliability and validity of the Face, Legs, Activity,Cry, Consolability observation tool as a measure of pain inchildren with cognitive impairment. Anesthesia & Analgesia 95(5):1224–9.Pediatric Palliative Care and Ethics ConsultantFebruary, Volume 16, Number 2, 2016 ajob 71 https://www.capc.org/fast-facts/10-tube-feed-or-not-tube-feedhttps://www.capc.org/fast-facts/10-tube-feed-or-not-tube-feed Copyright of American Journal of Bioethics is the property of Routledge and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder’s express written permission. However, users may print, download, or email articles for individual use.Ethical Dilemma: Pediatric Complexologist and a Pediatric Palliative Care and Ethics Consultant Essay.

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